10/6/2023 EnchantaVaughn Approved Behavior: Client was mildly talkative throughout the entire session. Client continues to display irritable and defiant behaviors, which made it hard to show client support. Counselor had to re-direct client by giving her two verbal prompts for not focusing during the session. Client was redirected 2-3x by her mom before given a final warning to get her act together or consequences would follow. Client failed to utilize appropriate coping strategies and communication skills within the home. Behavior: Client showed unwillingness to engage in the activities provided to her during the session. The client was assisted in identifying activities in which she can now be engaged as her psychotic symptoms have gradually debated. Client failed to take anything taught in therapy seriously, as evidenced by her aggressive behaviors throughout the session. Client was unable to focus today, due to hyperactive behaviors. Client ended the session with a pep talk and reflective thinking exercise. Intervention: QMHP emphasized how her mental illness is associated with underlying feeling of inadequacy and insecurity from past trauma. QMHP utilized a role-reversal technique to assist client with alternative ways to avoid negative interaction and to assist her with better decision-making skills. QMHP provided positive feedback when client engaged in the more appropriate behavior. QMHP reviewed methods and tactics to help client advocate for herself by the use of assertive communication and conflict resolution skills within her environment. Intervention: During the second half of the session, QMHP explored the underlying factors contributing to the client’s pattern of blaming others for her disruptive behaviors and negative attitude. QMHP listened to client verbalize her feelings towards making good decisions and avoiding conflicts with mom and other adult family members. QMHP redirected client to an alternative activity. QMHP provided guidance on alternative behaviors and clear instruction on the alternative behavior. QMHP encouraged client to be the example for her peers. Response: Client expressed a lot of her anxieties exist from other people saying mean things to her or picking on her. Client was reluctant and hesitant at this time. Client did not offer any forms of social or friendly rapport back to the QMHP, remaining unemotional displaying an unresponsive and nonchalant attitude throughout the session. Client showed lack of concern and empathy in response to positive cognitions. Client did not express verbal communication after positive reinforcement was provided. Response: Client communicates and displays undesirable traits at home and is learning to cope with her crisis situation with family and QMHP support. Client struggled to identify her stimulus that triggered her frustrated and angry emotions, indicating that she is unaware of her inappropriate behaviors. It was difficult for client to identify positive consequences of managing her anger. Client agrees to journaling her feelings, as she reflects on actions and consequences.